Provider Demographics
NPI:1558676536
Name:MICHOR, ANGELA IRENE (NP, MSN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:IRENE
Last Name:MICHOR
Suffix:
Gender:F
Credentials:NP, MSN
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:IRENE
Other - Last Name:POULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, MSN
Mailing Address - Street 1:13950 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2441
Mailing Address - Country:US
Mailing Address - Phone:414-302-5400
Mailing Address - Fax:414-302-5447
Practice Address - Street 1:13950 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2441
Practice Address - Country:US
Practice Address - Phone:414-302-5400
Practice Address - Fax:414-302-5447
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI153545363L00000X
WI4352-33363L00000X
WI153545-30163W00000X
WI4352363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse